Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation...
Transcript of Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation...
![Page 1: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/1.jpg)
Stress Management: Exploring the Relaxation Response
Professor of Medicine Harvard Medical School
Herbert Benson, M.D. Director Emeritus
June 20, 2014
![Page 2: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/2.jpg)
Learning Objectives
Upon completion of this course, participants will be able to: • Define the physiology and impact of stress and the
stress response • Name the tools used to increase self-regulation • Review the steps used to cultivate attention and
mindfulness • Identify the methods used to elicit the relaxation
response
![Page 3: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/3.jpg)
The Three-Legged Stool
Overall Health
Pharmaceuticals Surgery
Self-care
![Page 4: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/4.jpg)
Between 60-90% of healthcare visits are
related to M/B stress-induced
conditions
![Page 5: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/5.jpg)
CONDITIONS CAUSED OR EXACERBATED BY STRESS INCLUDE:
• Hypertension
• Cardiac Arrhythmias
• Chronic Pain
• Insomnia
• Side Effects of Cancer Therapy
• Side Effects of AIDS Therapy
• Anxiety
• Hostility
• Depression
• Premenstrual Syndrome
• Infertility
• Preparation for Surgery
and X-Ray Procedures
![Page 6: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/6.jpg)
180
200
220
240
260
280
300
320
12 min. 12 min. 12 min.
OX
YG
EN
CO
NSU
MP
TIO
N (c
c/m
in)
Pre Post Relaxation Response
Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120
![Page 7: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/7.jpg)
140
160
180
200
220
240
260
280
300
320
12 min. 12 min. 12 min.
CA
RB
ON
DIO
XID
E E
LIM
INA
TIO
N (
cc/m
inPre Post
Relaxation Response
Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120
![Page 8: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/8.jpg)
8
10
12
14
16
18
20
12 min. 12 min. 12 min.
RE
SPIR
AT
OR
Y R
AT
E (
brea
ths/
min
)Pre Post
Relaxation Response
Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120
![Page 9: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/9.jpg)
O2 Consumption During Sleep and The Relaxation Response
-20
-16
-12
-8
-4
0
4
0 1 2 3 4 5 6 7
Hours
Change in Oxygen Consumption (%)
Relaxation Response
Sleep
![Page 10: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/10.jpg)
TWO BASIC STEPS NECESSARY TO ELICIT THE RELAXATION RESPONSE
•The repetition of a word, sound, prayer, thought, phrase or muscular activity •The passive return to the repetition when other thoughts intrude
![Page 11: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/11.jpg)
The train of everyday thought is broken when the two basic steps to elicit the
relaxation response are followed.
![Page 12: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/12.jpg)
DIFFERENT TECHNIQUES ELICITING THE PHYSIOLOGIC CHANGES OF THE RELAXATION RESPONSE
Oxygen Consumption
Respiratory Rate
Heart Rate
Slow Brain Waves
Blood Pressure
Progressive Relaxation
Decrease Decrease Decrease Not Measured
Decrease
Autogenic Training
Not Measured
Decrease Decreases Increases Inconclusive Results
Zen and Yoga Decrease Decrease Decrease Increase Decrease
Presuggestion Phase of Hypnosis
Decrease Decrease Decrease Not Measured
Inconclusive Results
Transcendental Meditation
Decrease Decrease Decrease Increase Decrease
Simple Generic Techniques
Decrease Decrease Decrease Increase Decrease
![Page 13: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/13.jpg)
Frontal Frontal
Occipital
Frontal
Occipital
Frontal
Occipital Occipital
Control Beginning
Control End
RR Beginning
RR End
Vertical color bars indicate beta % power (white highest, black lowest).
Note: At RR End (lower right), beta % power is significantly (p<.0129) decreased in frontal areas. Jacob, et al, 1996
![Page 14: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/14.jpg)
Reduced Sympathetic Nervous System Responsivity Associated with the Relaxation Response
John W. Hoffman, Herbert Benson, Patricia A Arns, Gene L. Stainbrook,
Lewis Landsberg, James B. Young, and Andrew Gill
Science, 1982;215:190-2
![Page 15: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/15.jpg)
Functional Brain Mapping of the Relaxation Response using 3T fMRI
S.W. Lazar1,2, G. Bush1,2, G. Fricchione 3, R.L. Gollub1,2, G. Khalsa, H. Benson 3
1Department of Psychiatry, Harvard Medical School; 2NMR Center, MGH-East, CNY-9, Charlestown, MA 02129; and 3Mind/Body Medical Institute, Chestnut Hill MA 02467
![Page 16: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/16.jpg)
Experimental Paradigm Two identical 42-minute scans, each with two epochs of meditation and control. Meditation periods (12 min.) consist of observing the breath and repeating a mantra. Control periods (6 min.) consist of silently generating the names of animals.
Fix Control Meditation Fix Control Meditation Fix
0 1 7 19 22 28 40 42
Statistical Comparisons
“Meditation vs Control” compares the entire meditation period to the entire control period. This identifies regions with increased signal during the meditation period relative to the control period. “End vs Beginning” compares the last 2 minutes of the meditation period to the first two minutes of the meditation period. This identifies regions whose signal increases during the meditation practice.
![Page 17: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/17.jpg)
Signal Decreases Subject 4
Meditation vs. Control
![Page 18: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/18.jpg)
Signal Increases During Meditation Meditation vs. Control, n = 5
![Page 19: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/19.jpg)
fMRI Conclusions
The Relaxation Response induces specific changes in fMRI signal in several structures, including the amygdala,
hippocampus, pons, anterior cingulate, and intraparietal sulcus.
Many structures display steadily increasing fMRI signal
Throughout the Relaxation Response periods.
Some structures become less active as practice continues,
While other structures have a delayed onset of activity.
![Page 20: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/20.jpg)
The right BA 9/10 superior frontal and middle gyri and sulci and right anterior insula are significantly thicker in meditators versus age, gender and education matched controls.
B
p < 10-4 p < 10-2
1
3
4
2
A
Cortical Thickness
![Page 21: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/21.jpg)
VO2 vs Nitric Oxide
![Page 22: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/22.jpg)
Genomic Counter-Stress Changes Induced by the Relaxation Response
• Healthy Individuals: Matched for age, gender, race, height, weight and marital status
• Group M: 19 Long-term Practitioners of Daily RR Practice
• Group N1: 20 Controls
• Group N2: 20 N1 individuals who completed 8 weeks of RR training
Validation – Matched with above
• Group M: 6
• Group N1: 5
• Group N2: 5
![Page 23: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/23.jpg)
Techniques Utilized to Elicit the Relaxation Response
• Vipassna Meditation
• Mantra Meditation
• Mindfulness Meditation
• Transcendental Meditation
• Breath Focus
• Kripalu Yoga
• Kundalini Yoga
• Repetitive Prayer
![Page 24: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/24.jpg)
![Page 25: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/25.jpg)
Gene Ontology Analysis
![Page 26: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/26.jpg)
Heatmap of 15 Genes in the Intersection of All Three Groups on the Venn Diagram
![Page 27: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/27.jpg)
GSEA Analysis
![Page 28: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/28.jpg)
Gene Ontology Category Changes of the Relaxation Response
• Oxidative Phosphorylation
• Ubiquitin-dependent Protein Catabolism
• Nuclear Messenger RNA Splicing via Splicosome
• Ribosome
• Primary Metabolism
• Negative Regulation of Metabolism
• Regulation of Apoptosis
• Regulation of I-Κ B Kinase/ NF-Κ B Cascade
• Cysteine-Type Endo-Peptidase Activity
• Antigen Processing
![Page 29: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/29.jpg)
Opposite Common Genomic Expression in PTSD and Relaxation Response Practice
• Stress Response
• Inflammation
• Apoptosis
![Page 30: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/30.jpg)
Table: For all the comparison FDR=0.01 and P value <0.05 enriched genesets on short and long term relaxation response gene expression data: (
![Page 31: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/31.jpg)
Emergence: The Whole is Greater than the Sum of its Parts
For example, when a number of heart cells contract independently of each other, they don’t function meaningfully. But, when they contract in a coordinated interactive fashion, they can pump blood.
Other emergent examples include:
Ant colonies Human cities The Fight-or-Flight Response The Relaxation Response
![Page 32: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/32.jpg)
PE
RF
OR
MA
NC
E
EF
FIC
IEN
CY
High
Low
Low High
STRESS / ANXIETY
Yerkes-Dodson Law Stress-Performance Curve
![Page 33: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/33.jpg)
Relaxation Response Oxygen Consumption
and Exercise
10 20 30
MINUTES
VO2
(% Change)
10
0
-10
-20
Control group
Experimental group
PRE INTERVENTION POST
![Page 34: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/34.jpg)
Mean Changes in EEG-Defined Sleep Onset Latencies
100
80
60
40
20
0
Min
utes
Pre-treatment Post-treatment
77
11
19
13
![Page 35: Stress Management: Exploring the Relaxation Response · Stress Management: Exploring the Relaxation Response Professor of Medicine Harvard Medical School . Herbert Benson, M.D. Director](https://reader031.fdocuments.us/reader031/viewer/2022020303/5b75c1587f8b9aa01f8dcb64/html5/thumbnails/35.jpg)
References
• Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry 1974;37:37-46.
• Benson H. The relaxation response. New York: Morrow, 1975. • Benson H, Proctor W. Relaxation revolution. New York: Scribner,
2010 • Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW,
Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretions and inflammatory pathways. PLOS ONE, 2013, 8(5):e62817.